- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $707.95 / $1,995.26 / $10,471.29
| Facility | | $707.95 | $1,995.26 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $489.78 / $616.60 / $1,348.96
| Professional | | $489.78 | $616.60 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,698.24 / $1,698.24 / $1,737.80
| Facility | | $1,698.24 | $1,698.24 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $588.84 / $776.25 / $1,513.56
| Professional | | $588.84 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $741.31 / $741.31 / $2,818.38
| Facility | | $741.31 | $741.31 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $741.31 / $1,230.27
| Professional | | $549.54 | $741.31 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $851.14 / $851.14 / $1,288.25
| Professional | | $851.14 | $851.14 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $549.54 / $707.95 / $1,023.29
| Facility | | $549.54 | $707.95 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $794.33 / $954.99 / $1,122.02
| Professional | | $794.33 | $954.99 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $6,760.83 / $10,715.19
| Facility | | $2,344.23 | $6,760.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $446.68 / $588.84 / $1,122.02
| Professional | | $446.68 | $588.84 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $9,332.54 / $9,332.54 / $33,884.42
| Facility | | $9,332.54 | $9,332.54 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $4,073.80 / $4,073.80 / $4,897.79
| Professional | | $4,073.80 | $4,073.80 | $4,897.79 |